Health Promotion of The Adolescence and Family

Muhammad Syafiqi A M School of Nursing Health Science Faculty University of Muhammadiyah at Surakarta

March 12, 2012

Introduction
Adolescent is a period of transition between childhood and adulthood, a time of profound biologic, intellectual, psychosocial, and economic change. This period individuals reach physical and sexual maturity, develop more sophisticated reasoning abilities, and make educational and occupational decisions that will shape their adult careers. Adolescence involves three distinct subphases : early adolescence (ages 11 to 14), middle adolescence (ages 15 to 17), and late adolescence (age 18 to 20).

Biologic Development
Neuroendocrine Events of puberty :
Puberty involves a predictable sequence of hormonal and physical changes that occur universally over a defined period of time. The events of puberty are triggered by hormonal influences and are controlled by the anterior pituitary gland in response to a stimulus from the hypothalamus. Hormone production such us : GnRH by hypothalamus, it stimulates pituitary gland secretion of LH and FSH

Hormones
For females FSH stimulates growth of ovarian follicle, and production of estrogen. LH initiate ovulation, the formation of corpusluteum, and progesterone production. For males LH acts on testicular leydig cells, prompting maturation of the testicle and testosterone production. FSH acts with LH, stimulates sperm production.

Change in Reproductive Hormones

Females
Menstruation (release of an egg, or ovum from ovaries approximately 28 days). In early puberty, FSH stimulates estrogen production, however concentration of estrogen dont reach levels high enough to cause ovulation In mid puberty, the body produces estrogen in large amounts that results in lining endometrial of the uterus (first mens). One ovarian become dominant during each menstruation cycle and increases the estrogen amount during early cycle(follicular phases). The follicle then release ovum (ovulation process)

 By direct action, estrogen cause growth and development of the vagina, uterus, and fallopian tubes. The skin of labiamajora, as well as the breast areola and nipples, grows and darkens under influences of estrogen. Estrogen also responsible for breast enlargement and promotes growth of pubis, axillary hair, and widening of hip. At low levels estrogen tend to stimulate skeletal growth in both boys and girls, but higher levels it inhibits growth

Change in Reproductive Hormones

Males Development of viable sperm. During puberty, FSH acts on testicular cells, stimulating viable sperm production. FSH and LH, resulting in increased testosterone production. The production of viable sperm tends to follow boys first ejaculation. The capacity to ejaculate appears relatively early in boys sexual development, approximately 1 year after initial testicular enlargement and the appearance of pubic hair. Testosterone and other androgens have direct impact on growth of the penis, scrotum, prostate and seminal vesicles of the testicles. And also result increases in muscle mass, skeletal growth, bone age and bone density. In both sexes androgen responsible for development pubic, axillary, facial, and body hair . Clinically increased activity of androgen is associated with pubertal condition such us, acne, body odor, deepening voice, spurt in height, and increased re blood cells levels

Hypothalamus
GNRH
Anterior pituitary
Estrogen, Progesterone Testosterone

FSH +LH
Gonads
Testosterone (male) Estrogen (female)

Maturation and Release ovum

Primary and secondary sex characteristic

Spermatogenesis

Sexual Maturation
Girls
Appearance growth and development of pubis hair, breast development, and increasing of normal vagina discharge, associated with uterine development. Girls or the parents may be concerned that this vaginal discharge is sign of infection. The nurse ca reassure them that the discharge is normal and sign that uterus prepare of the menstruation. Late puberty is the first menstrual period (menarche). Initial menstrual period are usually scanty and irregular and may not be accompanied by ovulation.

 Ovulation and regular menstruation period usually begin 6 to 14 month after menarche. Menarche occur about 2 years after the appearance of breast buds approximately month after attainment of peak height and velocity, and 3 month after attainment of peak weight velocity. Sexual maturation influences young people satisfaction with their appearance but the effect appear to differ for girls and boys. Health promotion efforts related to pubertal growth, eating behavior, and body image are important for adolescence, especially early maturing girl.

Sexual Maturation in Boys The first pubescent change in boys are testicular enlargement with thinning, reddening, and increasing looseness of the scrotum. (9,5 and 14 years of age) The initial change appearance growth and development of pubic hair, penile and testicular enlargement. This period boys will undergo increasing muscularity, voice changes and dev of facial hair. Also functioning of genital will affect the ejaculation in puberty. Ejaculation may occur spontaneously as nocturnal emissions or wet dreams Health care professional can be resource for boys and provide appropriate information, and guidannce.

Cognitive Development
Emergence of Formal Operational Thought The sift from childhood to adolescence as a movement from concrete to formal operational thought For most young people emergence of formal operational thinking occurs between ages of 11 and 14. formal operational thought includes being be able to think in abstract terms, possibilities, think trough hypothese. Hypothetical reasoning is aligned with thinking possibilities and allows adolescent to systematically generate alternative possibility. And explanation and to compare what actually observe and possible believe

Adolescence conceptions of self

Adolescence be able to integrate these disparate observations of self into abstract personal characterizations. Being able to think about ones own thoughts and emotion can lead to periods of extreme self absorption.(cent egocentrism) Imaginary audience involves having heightened sense of self consciousness that an adolescent imagine everyone notice and focused on his or her behavior Thinking, called the personal fable, is the belief that ones feelings and experiences are completely unique, or that one is all knowing or invulnerable.

Development of value autonomy Advance in cognitive development, adolescence belief become more abstract and increasingly root in general ideologic principles. The adolescence will face with many conflict and should compare the advice from friends, teacher or parents. They have to make decision point that can be accepted in their environment. Adolescence begin to substitute a set of values distinct from those significant adults in their live.

Body Image
Characteristics of personality boys or girls manifested during childhood usually remain stable in the teenage years. The adolescence become more difficult because of the psychologic changes of adolescence and need to assert independence. Have sensitive response with act or influence related to negative characteristic or weakness. The nurse role may be to inform parents of different personality types and to help the support the teens uniqueness providing necessary structure and feedback

Gender Identity
These relationship become the basis for identity formation and generally a period of stress or crisis before strong identity can emerge The adolescence increasingly leaves the home base and establishes close ties with peers The adolescence try out new sport or skills, experimenting with alcohol, wearing different style of clothing and etc, related with their environment. Start realizing the duties and role of boys and girl in home or school. Also adolescence start have love and consideration feeling with their groups or friend. Privacy should be ensured during the taking of health histories or intervention with teens,

Social Development
The social environment provides opportunity, barriers, role models, and support individuals development. System within the social are family, peers, schools and community. All contribute uniquely to an adolescence health and development

Family Parent have a big role when the adolescence start new all change of physical and psychological. Close communication and attention to adolescence as helping process the adolescence find their identity. Adolescence prefer spend their time in no home to do new things. The health professional may give promotion to parents so that always observe and teach the adolescence.

Peers
Belief and make relationship with close friend and trust each other are usual behavior if the adolescence entrance new environment. Adolescence can decide the choices of relation with friend.

 Remaja masih mencari role models untuk membentuk kedewasaan Coping related choose the good role models

Thank You Wasslamualaikum Wr.wb